Highlights in child mental health research: December–January 2024

This month’s highlights include:

• The impact of storytelling on building resilience in children

This literature review explored the different forms and effects of storytelling interventions for developing resilience in children. The study found that storytelling improved mental health outcomes for children, including better resilience and decreased symptoms of depression, anxiety and behavioural problems.

• Grandparental care and child mental health

This meta-analysis synthesised international literature on the relationship between grandparental care and child mental health outcomes. The review looked at two types of grandparental care arrangements: ‘skipped-generation’ families (where grandparents were primary carers in the absence of parents) and multigenerational families (with co-parenting arrangements where parents and grandparents were living together). The meta-analysis found that grandparental care was associated with some small negative mental health effects for some children, but the effects varied across types of care and context and the study was not able to show causal relationships.

• Cyberbullying victimisation, emotional wellbeing and academic achievement in teens

This study explored cyberbullying victimisation in children aged 10 to 13 years and its later impacts on emotional wellbeing and academic achievement. The authors found that cyberbullying can have a direct and lasting impact on students’ learning outcomes. It can also lead to lower levels of emotional wellbeing, happiness and life satisfaction, as well as higher levels of sadness and worrying in the short term.

• School bullying in young people with neurodevelopmental and psychiatric conditions

This meta-analysis investigated the outcomes of bullying for young people with a diagnosis of neurodevelopmental or psychiatric conditions. The authors found that that young people with neurodevelopmental or psychiatric conditions had higher chances of being involved in cyberbullying as victims, perpetrators, and perpetrator-victims than those without these conditions. School bullying was also linked to negative mental health outcomes such as higher levels of internalising, externalising, general psychopathology, suicidality, and decreased functionality.

• Early risk factors for self-injurious thoughts and behaviours

This case-control study from the UK explored the role of early risk factors for suicidal ideation, suicide attempts, and non-suicidal self-injury occurring at 8–14 years old and for suicidal risks in young adulthood (between ages 18–25 years). Evidence suggested that some but not all early risk factors are linked to later mental health challenges and visits to general practitioners can have some weak protective effects against the issues continuing into young adulthood.

Why is this important?

• Storytelling is a communication tool used by parents to promote imagination, knowledge retention and prosocial behaviours in children across languages, cultures and countries. Limited research exists on how storytelling interventions impact on the development of protective factors in children including resilience.
• Understanding the effects of storytelling interventions on the development of resilience in children can guide effective interventions that are simple and adaptable across contexts and mental health settings.
• Resilience was defined as an important aspect of mental health and coping that enables children to effectively recover from difficult life events.

What did they do?

• The authors conducted a narrative literature review that included searches in 12 academic databases for studies in English without time or location limits.
• The review included 11 peer-reviewed studies on children aged 0-18 years, with a mix of quantitative and qualitative studies from Australia, US, Canada, Brazil, Europe, and South Africa.
• The review used a narrative synthesis approach to analyse the different forms and effects of storytelling interventions for supporting mental health outcomes and developing resilience in children.

What did they find?

• Storytelling was associated with better mental health outcomes (reduced anxiety, depression and behavioural problems) for children, supporting both emotional and social development.
• Storytelling interventions also increased psychological protective factors against the development of anxiety disorders, such as coping skills and perceived self-efficacy.
• Positive psychology-based storytelling interventions improved psychological resilience in children and had sustainable effects.
• The key themes in qualitative studies were mostly about how stories of hope and perseverance prompted children to identify and reflect on psychological factors associated with resilience, and the role of people, family and community in their lives.

What does this mean for practice?

• Positive mental health outcomes for children can be supported by storytelling
• Storytelling interventions have the potential to be simple and easily adaptable solutions in limited resource contexts and across different cultures and languages. They can teach children about coping with hardships, finding meaning in difficult experiences, exploring resources and mechanisms needed to build resilience.

Why is this important?

• The number of children living in families where grandparents play a significant caregiving role is growing worldwide. However, the effects of grandparental care on children’s mental health aren’t yet well understood.
• This meta-analysis reviewed international evidence on the relationship between grandparental care and child mental health outcomes, including internalising problems, externalising problems, overall mental health challenges, and socioemotional well-being. It also assessed evidence for the moderating factors of grandparental care across participant and study characteristics.

What did they do?

• The authors defined grandparental care broadly as grandchildren being cared for by their grandparents. This included ‘skipped-generation’ families (where grandparents were primary carers in the absence of parents) and multigenerational families (with co-parenting arrangements where parents and grandparents were living together).
• The authors searched for cross-sectional or longitudinal (i.e., quantitative) peer-reviewed studies written in English or Chinese, published between 1977 to 2023.
• Thirty-eight studies were included that represented data on 344,860 children (average age 10.3 years).
• A moderator analysis was conducted to explore the variation in effect sizes across studies. Examples of moderators included recruitment setting (i.e., community-based, school-based), participants’ age, gender, region and cultural context of the study country (i.e., whether the country’s culture has predominantly individualistic or collectivistic values), living area (i.e., urban or rural areas) and family type (i.e., multigeneration or skipped-generation families).

What did they find?

• Most studies on grandparental care were from China (19 studies) and the United States (14 studies), followed by Europe (3 studies), South Africa and South Korea (1 study each).
• Most types of households were multigenerational households (21 studies), followed by skipped-generation households (17 studies).
• Grandparental care was influential on child mental health outcomes, but effects varied across types of care and contexts. The influences on mental health were generally small negative effects. The study found some positive protective effects from grandparental care for families where parents and grandparents co-parent together (multi-generational households).
• Cross-sectional studies (that comprised 71% of the included studies) showed larger negative effects on children from grandparental care compared to longitudinal studies, however, the cross-sectional study design doesn’t account for causal relationships.
• Children who end up in grandparental care often come from families experiencing vulnerabilities, with multiple other risk factors that may contribute to children’s worse mental health through compounding effects.
• The explanatory factors for why grandparental care may produce worse mental health outcomes for children included ineffective discipline or low nurturance and grandparents’ poorer physical health (low energy, poor health) or mental health status. Not knowing how to support child development was relevant for ‘left-behind children’ whose parents had migrated due to work.
• The study found some positive protective effects from grandparental care for families in which parents and grandparents co-parented. Children living in these co-parenting situations had fewer behavioural problems compared to children in the care of parents, possibly because grandparents also provided parenting support in addition to knowledge and attachment support to children.

What does this mean for practice?

• The review suggests that grandparental care (particularly for skipped generation families) is associated with small decreases in child mental health, however, the effects vary greatly across cultural contexts and parenting arrangements. The authors suggest that the association between poorer child outcomes may be influenced by the nature of grandparent care but also by the family circumstances of children in grandparent care. More research is needed to explain the associations between child mental health and grandparental care.
• It is essential to understand that grandparents may have specific challenges and support needs when they care for children and young people. When these needs are unmet, it may negatively impact the mental health of children in their care.
• There is a need for supportive programs and interventions for grandfamilies, particularly in communities experiencing vulnerabilities. Children growing up in these types of families may benefit from early mental health interventions.

Why is this important?

• Adolescence is a critical period of development and transition. Cyberbullying victimisation during this period can have significant negative impacts on mental health and wellbeing. Research is needed to better understand the long-term effects on wellbeing and academic outcomes of experiencing cyberbullying in the pre-teen years (before age 13).
• Cyberbullying was defined as repeated and ongoing intentional harm to another using electronic or digital media.

What did they do?

• This cohort study analysed longitudinal associations using data from the annual Wellbeing and Engagement Collection survey that captures learning and participation data for South Australian government school students.
• The study included data on 9,139 South Australian students (aged 10–13 years) whose cyberbullying status was reported in Grade 6. Their emotional wellbeing and academic achievement outcomes were measured in Grades 7 and 9.
• The authors assessed the links between cyberbullying and emotional wellbeing. This included emotion regulation outcomes and two aspects of wellbeing: positive (e.g., happiness, life satisfaction) and negative wellbeing (e.g., sadness, worries).
• The researchers used a mixed effects modelling approach for the data analysis.

What did they find?

• Cyberbullying can have a direct and lasting impact on students’ learning outcomes.
• Cyberbullying victimisation in early adolescence (Grade 6) was associated with lower levels of positive emotional wellbeing (happiness and life satisfaction) and higher levels of negative emotional wellbeing (sadness and worries) in the short term (Grade 7).
• Cyberbullying victimisation in early adolescence was also associated with lower levels of academic achievement (reading and numeracy) in both the short term (Grade 7) and the long term (Grade 9). The analysis demonstrated these negative and lasting impacts on wellbeing even after accounting for a range of other child, peer, school and community factors.

What does this mean for practice?

• Practitioners should be aware that victims of cyberbullying can experience emotional issues and academic performance issues for several years after being cyberbullied.
• There is a need for more school-based mental health and socio-emotional skill development programs to reduce the impacts of cyberbullying.
• Early intervention and prevention strategies are important to prevent negative mental health and wellbeing effects of cyberbullying later in life.
• A holistic approach is best suited to address the effects of cyberbullying.
• School programs on the prevention of cyberbullying in younger grades can help promote understanding and prevent potential negative effects from occurring.

Why is this important?

• Bullying is a common form of violence that children and adolescents are exposed to in school environments. Young people with neurodevelopmental or psychiatric conditions could be at higher risk of bullying victimisation and perpetration.
• This article examined the prevalence of bullying among children and adolescents (aged 4-17 years) with neurodevelopmental or psychiatric conditions.
• Bullying was defined as traditional (physical, verbal, or relational) or as cyberbullying (intentional and repeated harm inflicted through electronic devices and social media).

What did they do?

• This meta-analysis included literature reporting on bullying outcomes for young people with a diagnosis of neurodevelopmental or psychiatric conditions (as per the DSM-5 diagnostic handbook). Examples of neurodevelopmental conditions included attention-deficit hyperactivity disorder, autism, communication disorders, intellectual disabilities, motor disorders, specific learning disorders. Examples of psychiatric conditions included affective disorders, anxiety disorders and conduct disorders. The analysis also included mixed samples with multiple diagnoses and groups with special educational needs.
• 212 studies were included reporting on outcomes for 126,717 children and adolescents (mean age 12.34 years). It also used a control group of 504,806 children.
• The authors used random-effects meta-analyses to estimate prevalence and odds ratios for bullying involvement. Bullying involvement was categorised as victimisation, perpetration, or perpetration–victimisation. Sub-group analysis was conducted for psychiatric or neurodevelopmental conditions as well as individual diagnoses where possible.

What did they find?

• The study showed that young people with neurodevelopmental or psychiatric conditions had higher chances of being involved in both traditional and cyberbullying as victims, perpetrators, and perpetrator-victims than those without these conditions.
• The study found that bullying involvement (as either perpetrator, victim or perpetrator-victim) was associated with worse mental health outcomes, such as higher levels of internalising, externalising, general psychopathology, and suicidality, and lower levels of functionality in young people with neurodevelopmental or psychiatric conditions.

What does this mean for practice?

• Practitioners should be aware that involvement in bullying and cyberbullying – whether as perpetrators, victims or perpetrator-victims – is a significant risk factor for increased mental health issues in children and young people with neurodevelopmental or psychiatric conditions.
• There is a need for interventions and programs that support the mental health of young people who are or have been involved in bullying and who have neurodevelopmental and psychiatric conditions.

Why is this important?

• Suicide is the fourth leading cause of death for young people. Early identification of risk factors for suicide, such as self-injurious thoughts and behaviours, is important since most mental health problems begin in childhood or adolescence. Self-injurious thoughts and behaviours (SITB) are also linked to higher healthcare costs, loss of functionality and quality of life.
• This study explored the role of early risk factors for suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI) occurring at 8–14 years old, for suicidal risks in young adulthood (between ages 18–25 years).

What did they do?

• The authors conducted a secondary analysis of existing data from the Clinical Practice Research Datalink (CPRD) database (from 1987 to 2021).
• This was a case-control study of 219,581 young people aged between 18-24 years with mental health problems treated in primary care settings in the UK. Within the sample, 14,288 children had self-injurious thoughts and behaviours at the time of entering the study and 205,293 children did not.
• All young people included in the study had consulted a GP at least once between the ages of 8 and 14 for a mental health problem (including behavioural and eating disorders; anxiety symptoms, mood symptoms, psychotic symptoms; NSSI and suicidal ideation).

What did they find?

• Among young people (18-24 years) who had attempted suicide, 15.67% had visited a GP due to suicidal ideation and 10.95% due to NSSI.
• The early risk factors for non-suicidal self-injuries in young people at age 18-24 years included early suicidal ideation, history of sexual abuse, behavioural problems, mood symptoms, early NSSI, and psychotic symptoms. The early risk factors linked to suicidal ideation were the same as above but did not include mood symptoms.
• The early risk factors for suicide attempts included history of sexual abuse, behavioural problems, NSSI, and older age at first visit. The study didn’t find a significant link between early suicidal ideation and later suicide attempts.
• NSSI between ages 8-14 years was associated with increased later odds of suicidal ideation, NSSI and suicide attempts. Early suicidal ideation didn’t have an effect on later suicide attempts.
• Males aged 18-24 were at higher risk of suicidal ideation and suicide attempts than females at the same age.
• Frequent early GP visits (between the age of 8 and 14) were associated with decreased odds of later SITB at the age of 18-24. GP visits also had a weak protective effect against later NSSI and suicide attempts.

What does this mean for practice?

• GPs can play an important role as an early point of access to mental health services, including recognising early symptoms of emotional and mental health challenges.
• Practitioners should be aware of early risk factors for suicide for young people, such as suicidal ideation, mood and psychotic symptoms, sexual abuse, and behavioural symptoms.
• Practitioners may benefit from training in suicide risk assessment to better recognise risk factors and support young people at risk of suicidal thoughts and behaviours.